Dismissed from Residency Program 3rd Year

[rdoctor1234]

Hi,

I am currently suspended from my residency program in the 3rd year due to rubbing people the wrong way. Basically, the issue has nothing to do with my competencies or ability to perform the job well, but it is strictly related to communication issues with the program director and nurses at the hospital. I'm now at the risk of getting dismissed and am curious as to what my chances are to be able to transfer to a different program to finish. I already have fellowship offers lined up for next year and need to complete by then. Any thoughts on inquiring about finishing my residency where I have received fellowship offers? Any other suggestions are warmly welcomed! Thanks in advance.

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[SouthernSurgeon]

Hi,

I am currently suspended from my residency program in the 3rd year due to rubbing people the wrong way. Basically, the issue has nothing to do with my competencies or ability to perform the job well, but it is strictly related to communication issues with the program director and nurses at the hospital. I'm now at the risk of getting dismissed and am curious as to what my chances are to be able to transfer to a different program to finish. I already have fellowship offers lined up for next year and need to complete by then. Any thoughts on inquiring about finishing my residency where I have received fellowship offers? Any other suggestions are warmly welcomed! Thanks in advance.

You seem remarkably under concerned about a potentially career ending problem.

Any fellowship offers will quickly dry up when they realize you’ve been fired. They may even disappear after a suspension.

The odds of another residency program taking you in advanced standing after a dismissal approach zero.

Your best, and nearly only, option is to beg plead and grovel to your own program to allow you to continue on.

 

[Winged Scapula]

You seem remarkably under concerned about a potentially career ending problem.

Any fellowship offers will quickly dry up when they realize you’ve been fired. They may even disappear after a suspension.

The odds of another residency program taking you in advanced standing after a dismissal approach zero.

Your best, and nearly only, option is to beg plead and grovel to your own program to allow you to continue on.

In addition, I believe most specialities require that you spend the *entire* final year (at least) at the same program, so "transferring" to another program means starting 3rd year over.

If we knew the OP's specialty, we could speak more eloquently about these requirements.

 

[rokshana]

Hi,

I am currently suspended from my residency program in the 3rd year due to rubbing people the wrong way. Basically, the issue has nothing to do with my competencies or ability to perform the job well, but it is strictly related to communication issues with the program director and nurses at the hospital. I'm now at the risk of getting dismissed and am curious as to what my chances are to be able to transfer to a different program to finish. I already have fellowship offers lined up for next year and need to complete by then. Any thoughts on inquiring about finishing my residency where I have received fellowship offers? Any other suggestions are warmly welcomed! Thanks in advance.

you need to figure out how "not to rub people the wrong way" for the next 8 months...which means you need to keep your head down and not have ANY conflicts with ANYONE...do not get onto any interactions with the nurses other than the minimal that you need to do so to take care of pts...answer their pages promptly and do what is needed to have as little interaction with them.

as stated above, beg and pled and profusely apologize for whatever issues you have had with your PD and tell him/her that they won't happen again.

you don't seem to realize that these kind of communication and personality difficulties are far bigger red flags than medical knowledge or job performance...those you can fix...people will see you being difficult to get along with as a permanent problem.

to transfer out, you will need the support of your PD...if you are having difficulties with said PD, your chances are practically nil.

 

[Crayola227]

attitude is soooooooo wrong

your program wanting to fire you over communication issues... huge professionalism issue, huge red flag
it seems that your insight into the seriousness of not only your employment situation, but the problems causing them, is limited

find the humility, review the evals, see if there's any way you can get outside yourself, see yourself as others are
intentions don't matter in these things, seeing as you're clearly coming off in a way you don't intend, yes?? in fact, seems you are here in this anonymous forum as well

So you need to come to terms with the negative things being said about you.
You need a come to Jesus moment about yourself or at least what the program now believes about you.
You need to identify concrete ways to address these issues that will be satisfactory to the offended parties.
You need to figure out a way to effectively and sincerely communicate (sigh) to your program, that you understand the seriousness of these issues, you are picking up exactly what they are putting down, and how you would like to address this moving forward.
You need to make it clear you take full responsibility and will do whatever it takes to successfully complete your program.

Your program needs to think you WANT to remediate, and that you CAN - the ability to. The fact they are moving to dismissal likely means they don't believe one or the other. I don't believe either coming from you from one post.

Check yourself before you wreck yourself.

Being this close to program graduation, depending on the structure of the program and the nature of your last year, it really might not be that much skin off their back to cut you, so don't think because you're a resident-almost attending that they can't just end you with little inconvenience (from a resident POV. Apparently for GME it's more complicated than I make it sound, but I've never talked to a terminated resident that didn't feel like it happened far more easily than they ever could have imagined).

Normally I tell people to lawyer up, etc etc, but in your case, I'm not getting a vibe about discrimination or health issues. It might be personality, they just don't like you. As a doctor, you actually do need people to like you sorta some of the time.

In any case, it doesn't matter if a lawyer would or would not be helpful to you; nothing gets you out of the necessity of crawling on your hands and knees to your program and kissing their feet in an attempt to make them think you can change and take you back.

 

[Crayola227]

also, 99% of the time the fantasy of escaping the bed you're lying in by transferring to another program... is just that, a fantasy

transferring always requires some cooperation/support from your current program.... let me ask you, are you feeling supported right now??

transferring is easier for them to support/you to convince another program is a good idea, when you're switching *specialties* because the issue isn't you per se, but the medicine type you're practicing

family/geography, and to a lesser extent, "fit" can also make a transfer happen

what is the PD going to say about you when another PD calls to ask if they should employ you?

 

[Crayola227]

lastly, you could search through my past post history on the topic of resident dismissal to explore how you might avoid termination and get a resignation, but both are potentially career ending moves, one is possibly easier to come back from than the other, or has certain advantages

both are to be avoided at all costs, however, and you should only explore resignation when termination seems inevitable because there is no chance of reconciliation, remediation, continuation

 

[Bobblehead]

Hi,

I am currently suspended from my residency program in the 3rd year due to rubbing people the wrong way. Basically, the issue has nothing to do with my competencies or ability to perform the job well, but it is strictly related to communication issues with the program director and nurses at the hospital. I'm now at the risk of getting dismissed and am curious as to what my chances are to be able to transfer to a different program to finish. I already have fellowship offers lined up for next year and need to complete by then. Any thoughts on inquiring about finishing my residency where I have received fellowship offers? Any other suggestions are warmly welcomed! Thanks in advance.

The following very recent quote is a reply to someone in a similar situation in another thread. It is quite relevant to your situation. You should read it in its entirety and take it to heart.

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong. When it's a communication problem it tends to be how you say things, not the actual content. There's no problem if we disagree about a clinical decision and we debate it -- but it can be a problem if how you're perceived is aggressive, unwilling to compromise, and/or unable to see that your decision isn't correct. Sometimes it's an issue of "fighting for the patient" rather than "compromising and doing what the system will allow". Scores on your "professionalism" in your RMS are not helpful here. One attending offering to vouch for you is also missing the point -- everyone can find one person to vouch for them. Residents with professionalism / communication issues end up with a large minority of people who feel they have a problem -- and that's a problem. Just because a majority of people think you're "fine" doesn't mean that you're fine.

 

[Gastrapathy]

Everything written above is right. You are in a desperate state of affairs. And just to be clear, your fellowship offers no longer exist.

 

[WingedOx]

Examples of "rubbing people the wrong way" may be helpful here.

 

[Triple Cheeseburger]

Examples of "rubbing people the wrong way" may be helpful here.

Are you speaking figuratively or literally? Did you pull a Weinstein? LOL, but a few examples would be helpful.

 

[DIANA2017]

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong. When it's a communication problem it tends to be how you say things, not the actual content. There's no problem if we disagree about a clinical decision and we debate it -- but it can be a problem if how you're perceived is aggressive, unwilling to compromise, and/or unable to see that your decision isn't correct. Sometimes it's an issue of "fighting for the patient" rather than "compromising and doing what the system will allow". Scores on your "professionalism" in your RMS are not helpful here. One attending offering to vouch for you is also missing the point -- everyone can find one person to vouch for them. Residents with professionalism / communication issues end up with a large minority of people who feel they have a problem -- and that's a problem. Just because a majority of people think you're "fine" doesn't mean that you're fine.


I think this post sums up my situation. I was essentially fighting for a patient, who would have been fine without my intervention. I want to use the appeal to apologize to my PD and all the attending involved. I do not have hope for reinstatement-it never happens in my program I was told by HR lady. And to make matters worse there was a co-fellow/bully who essentially alienated me from all other fellows by bad mouthing me, exposing my past mistakes and disrespecting me in front of them. He was remediated by HR but restarted his behavior. I think he is part of the way things turned out for me. HE would act as a mole reporting every single move to my PD, often accusing me of being late when I went straight to wards instead of stopping by office first.

 

[AdmiralChz]

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong. When it's a communication problem it tends to be how you say things, not the actual content. There's no problem if we disagree about a clinical decision and we debate it -- but it can be a problem if how you're perceived is aggressive, unwilling to compromise, and/or unable to see that your decision isn't correct. Sometimes it's an issue of "fighting for the patient" rather than "compromising and doing what the system will allow". Scores on your "professionalism" in your RMS are not helpful here. One attending offering to vouch for you is also missing the point -- everyone can find one person to vouch for them. Residents with professionalism / communication issues end up with a large minority of people who feel they have a problem -- and that's a problem. Just because a majority of people think you're "fine" doesn't mean that you're fine.


I think this post sums up my situation. I was essentially fighting for a patient, who would have been fine without my intervention. I want to use the appeal to apologize to my PD and all the attending involved. I do not have hope for reinstatement-it never happens in my program I was told by HR lady. And to make matters worse there was a co-fellow/bully who essentially alienated me from all other fellows by bad mouthing me, exposing my past mistakes and disrespecting me in front of them. He was remediated by HR but restarted his behavior. I think he is part of the way things turned out for me. HE would act as a mole reporting every single move to my PD, often accusing me of being late when I went straight to wards instead of stopping by office first.

In the light of all the recent fake posts about dismissals, I am unsure if I believe this poster. There’s nothin concrete here just strange ramblings about coworkers.

To give the OP the benefit of the doubt - a sure way to block your reinstatement would be to blame it all on coworkers rather than taking responsibility as you are doing here.

 

[Asteroid Body]

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong. When it's a communication problem it tends to be how you say things, not the actual content. There's no problem if we disagree about a clinical decision and we debate it -- but it can be a problem if how you're perceived is aggressive, unwilling to compromise, and/or unable to see that your decision isn't correct. Sometimes it's an issue of "fighting for the patient" rather than "compromising and doing what the system will allow".

I think this post sums up my situation. I was essentially fighting for a patient, who would have been fine without my intervention.

You've read all the literature on 'disruptive physician behavior' right? Because, you really should be familiar with it by now. It should be included in first year medical school lectures, as fair warning.

 

[HomeSkool]

I agree with most of what's been said to this point. If your program's ready to dismiss you, it means one of two things: either you've done something particularly egregious or you have a sustained pattern of interpersonal problems despite repeated admonition and opportunities to change. Neither scenario is a good one, as the former indicates a glaring lack of judgment and the latter demonstrates unwillingness to receive correction. In either case, interpersonal difficulties of this magnitude won't resolve by transferring elsewhere.

Your current residency program is the key to any future success you may have. If you were to try transferring to another program, don't you think the first thing they'd ask is what happened at your first program and what you'd done to correct it? Don't you think the first person they'd call is your current PD? The issues you've had at your current program will haunt you forever until they're addressed at the source.

I'm going to disagree with some of the other posters and say that it doesn't really matter what "communication issues" you've had. The fact is that you've had them, other residents in your program haven't, and your current PD holds the key to your future. You need to figure things out with him/her if you ever hope to move forward.

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[OrthoTraumaMD]

Basically, the issue has nothing to do with my competencies

Um...yes it does. Professionalism is one of the six ACGME core competencies.



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[Crayola227]

I agree with most of what's been said to this point. If your program's ready to dismiss you, it means one of two things: either you've done something particularly egregious or you have a sustained pattern of interpersonal problems despite repeated admonition and opportunities to change. Neither scenario is a good one, as the former indicates a glaring lack of judgment and the latter demonstrates unwillingness to receive correction. In either case, interpersonal difficulties of this magnitude won't resolve by transferring elsewhere.

Your current residency program is the key to any future success you may have. If you were to try transferring to another program, don't you think the first thing they'd ask is what happened at your first program and what you'd done to correct it? Don't you think the first person they'd call is your current PD? The issues you've had at your current program will haunt you forever until they're addressed at the source.

I'm going to disagree with some of the other posters and say that it doesn't really matter what "communication issues" you've had. The fact is that you've had them, other residents in your program haven't, and your current PD holds the key to your future. You need to figure things out with him/her if you ever hope to move forward.

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I will add, especially since other residents might read this, that the specific issues *may* matter in terms of this resident figuring out how to approach the topic of remediation and reconciliation with their program..

The program will want to see that this resident has insight into these issues and some things to say that the resident understands these problems and has specific believable ideas how to address them. Hand waving "I'm sorry I'll try to change" isn't going to cut it this close to termination. That might not be the extent of what is needed here, but I can't see how it will hurt. My understanding, from experience, is that is exactly the minimum the program expects when communication is a cited professionalism issue.

I agree that the PD holds the keys and needs to figure it out with them. I think the above might be one piece of how. So I'm not sure what you mean.

 

[Crayola227]

Um...yes it does. Professionalism is one of the six ACGME core competencies.



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some people seem to think that competency is just about putting the right orders and such

those also tend to be the people who end up having "professionalism issues surrounding communication"

 

[GMEComplianceProject]

Good advice above. I would also interject the possibility that the resident may not be entirely at fault. I've been following some issues of toxic faculty and programs which violate ACGME requirements for evaluative and due processes for residents.Regardless of etiology, it's imperative to address these issues early and proactively.

 

[FellowPaisan]

Hi,

I am currently suspended from my residency program in the 3rd year due to rubbing people the wrong way. Basically, the issue has nothing to do with my competencies or ability to perform the job well, but it is strictly related to communication issues with the program director and nurses at the hospital. I'm now at the risk of getting dismissed and am curious as to what my chances are to be able to transfer to a different program to finish. I already have fellowship offers lined up for next year and need to complete by then. Any thoughts on inquiring about finishing my residency where I have received fellowship offers? Any other suggestions are warmly welcomed! Thanks in advance.

message me where you are at. I am in a similiar area. But the other poster is right. How you treat people speaks to how you respect others and the field of medicine. For you to be pretty nonchalant about everything is quite concerning.

 

[erroll]

The tone of the post may seem weird for the situation the OP claims to be in, but I find equally if not more out of place almost everyone's reaction, too much jumping into conclusions and judging the poster as the kind of problem resident of your choice, with so little information given to back up such assumptions.

 

[qxrt]

I'm nearing the end of my chief resident year, and I've picked up some valuable lessons along the way. Here are a couple key points in regards to personality issues/non-clinical conflicts for anyone else who might gather something useful from this thread:

1) People talk. Any problems, personality or clinical-wise, almost always get discussed in the hallways, elevators, etc. as gossip long before they arrive on paper in the form of evaluations and formal meetings/discussions with the program director. If you get called for a potential problem, and your response is that no one ever filed a formal complaint or said anything in your evaluations yet, then you are behind the ball and did not realize that discussions about your behavior were already taking place informally. It is always good to keep your ears to the ground and be vigilant about dealing with any small issues before they become bigger, more official issues.

2) Don't be full of yourself, and always be willing to keep an open ear and learn. Assuming a threshold of competence, the biggest problem residents don't always tend to be the ones who are clinically struggling, but rather the ones who tend to assume the worst in others and constantly assume that others are not pulling their weight or are doing an incompetent job. This problem tends to be more prevalent in senior residents, who, on obtaining a baseline level of comfort in their specialty, now assume that they have the authority to call out other people on every little thing. This is a huge problem, as once you cross over the line into attending-hood, you can be assured that there is almost no one who will be willing to call you out on it unless it gets to a breaking point; not your colleagues, not the midlevels, not the nurses, no one. Value your time in residency as one of the last few times that you can get an attending who can call you out on your bull**** or attitude, as there will be no one after that. Don't squander the opportunity to become aware of some major (or minor) personality conflicts or problems!

 

[agranulocytosis]

I'm nearing the end of my chief resident year, and I've picked up some valuable lessons along the way. Here are a couple key points in regards to personality issues/non-clinical conflicts for anyone else who might gather something useful from this thread:

1) People talk. Any problems, personality or clinical-wise, almost always get discussed in the hallways, elevators, etc. as gossip long before they arrive on paper in the form of evaluations and formal meetings/discussions with the program director. If you get called for a potential problem, and your response is that no one ever filed a formal complaint or said anything in your evaluations yet, then you are behind the ball and did not realize that discussions about your behavior were already taking place informally. It is always good to keep your ears to the ground and be vigilant about dealing with any small issues before they become bigger, more official issues.

2) Don't be full of yourself, and always be willing to keep an open ear and learn. Assuming a threshold of competence, the biggest problem residents don't always tend to be the ones who are clinically struggling, but rather the ones who tend to assume the worst in others and constantly assume that others are not pulling their weight or are doing an incompetent job. This problem tends to be more prevalent in senior residents, who, on obtaining a baseline level of comfort in their specialty, now assume that they have the authority to call out other people on every little thing. This is a huge problem, as once you cross over the line into attending-hood, you can be assured that there is almost no one who will be willing to call you out on it unless it gets to a breaking point; not your colleagues, not the midlevels, not the nurses, no one. Value your time in residency as one of the last few times that you can get an attending who can call you out on your bull**** or attitude, as there will be no one after that. Don't squander the opportunity to become aware of some major (or minor) personality conflicts or problems!

Never thought of it like this, but a very good point. Reflecting back, this is probably the most true statement I've read on the SDN in a long time. PGY-7 here, going on 8.

 

[BGDino]

I'm nearing the end of my chief resident year, and I've picked up some valuable lessons along the way. Here are a couple key points in regards to personality issues/non-clinical conflicts for anyone else who might gather something useful from this thread:

1) People talk. Any problems, personality or clinical-wise, almost always get discussed in the hallways, elevators, etc. as gossip long before they arrive on paper in the form of evaluations and formal meetings/discussions with the program director. If you get called for a potential problem, and your response is that no one ever filed a formal complaint or said anything in your evaluations yet, then you are behind the ball and did not realize that discussions about your behavior were already taking place informally. It is always good to keep your ears to the ground and be vigilant about dealing with any small issues before they become bigger, more official issues.

2) Don't be full of yourself, and always be willing to keep an open ear and learn. Assuming a threshold of competence, the biggest problem residents don't always tend to be the ones who are clinically struggling, but rather the ones who tend to assume the worst in others and constantly assume that others are not pulling their weight or are doing an incompetent job. This problem tends to be more prevalent in senior residents, who, on obtaining a baseline level of comfort in their specialty, now assume that they have the authority to call out other people on every little thing. This is a huge problem, as once you cross over the line into attending-hood, you can be assured that there is almost no one who will be willing to call you out on it unless it gets to a breaking point; not your colleagues, not the midlevels, not the nurses, no one. Value your time in residency as one of the last few times that you can get an attending who can call you out on your bull**** or attitude, as there will be no one after that. Don't squander the opportunity to become aware of some major (or minor) personality conflicts or problems!

Oh yeah. And something that my department head taught me last year (which I’m still forgetting occasionally) - once you become a consultant (attending), the same thing you might have said as a registrar (resident) now carries far more power behind it because of your position, so can be interpreted differently.

Also, as a junior consultant (attending) I think having a mentor is one of the most valuable things you can have. Someone who can still watch out for you and (gently) pull you up when you’re going the wrong way. I know couldn’t do without mine!

 

[WingedOx]

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong

I know I'm responding to an old post, but this is more than a little wrong.

 

[hamstergang]

I know I'm responding to an old post, but this is more than a little wrong.

Just so you know, that poster was just bad at using the quote button:

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong.

 

[WingedOx]

Just so you know, that poster was just bad at using the quote button:

Ah, noted.

Though I keep looking at cases like Stepanie Waggel, where the communication issues were pervasive from day one.